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Because of the critical role CYP24A1 plays in regulating the bioavailability and action of 1,25(OH)2D, the pharmacological effects of CYP24A1 inhibitors may be magnified in patients with renal insufficiency or failing kidneys [51]. For this reason, the development of CKD is associated with a significant increase in serum 1,25(OH)2D levels, which is driven at least in part by increased production of this active metabolite via increased CYP24A1 activity [6].
Although sufficient data are available to suggest that CYP24A1 inhibitors are a reasonable therapeutic option for patients with vitamin D deficiency, there remains a lack of consensus regarding the optimal dose and timing of treatment with these agents [6]. The optimal dose of paricalcitol used to correct vitamin D deficiency is likely determined based on the degree of deficiency, total body vitamin D stores, presence of secondary hyperparathyroidism, and patient comorbid conditions [6].
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